老年腹腔镜结直肠癌腹腔镜中转开腹手术对患者短期预后的影响
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摘要
目的探讨老年腹腔镜结直肠癌患者腹腔镜中转开腹手术对患者的短期预后影响。方法选择行结直肠癌手术的109例老年患者的临床资料进行回顾性分析。按照手术方式不同分为3组,A组61例为腹腔镜手术组、B组30例为开腹手术组、C组18例为腹腔镜中转开腹手术组。分析中转开腹的原因并比较各组患者围术期相关指标和术后并发症发生情况。结果老年腹腔镜结直肠癌手术中转开腹的原因主要有肿瘤与周围组织黏连、肠管水肿、肿瘤体积大、位置固定和腹腔镜操作困难等。B组的手术时间最短,C组的手术时间最长,A组手术时间介于B组和C组之间,三组比较均有显著性差异(P <0. 05); A组的术中出血量、排气时间、排便时间、恢复进食时间和住院时间均显著短于B组和C组(P <0. 05),而B组和C组比较无统计学差异(P> 0. 05); A组患者的切口感染和腹腔感染发生率显著低于B组和C组(P <0. 05),而B组和C组相比无统计学差异(P> 0. 05);三组吻合口瘘、吻合口出血、肠梗阻、二次手术和肺部感染相比均无统计学差异(P> 0. 05)。结论老年结直肠癌患者行腹腔镜手术临床效果较好,但腹腔镜中转开腹手术与开腹手术的短期预后相当,并未对老年患者造成更大的影响。
Objective To investigate the effect of short-term prognosis on conversion of laparoscopic colorectal cancer surgery to open surgery of old patients. Methods 109 elderly patients with colorectal cancer surgery were selected,and were divided into 3 groups according to the surgical method,61 patients underwent laparoscopic surgery in group A,30 patients underwent open surgery in group B,and 18 patients underwent conversion of laparoscopic surgery to open surgery in group C. The causes of conversion were analyzed and the related indexes of perioperative period and postoperative complications were compared. Results The causes of laparoscopic colorectal cancer surgery in elderly patients were mainly due to the adhesion of the tumor and surrounding tissues,edema of the intestinal canal,large tumor volume,location fixation and the difficulty of laparoscopic operation.The operation time of group B was the shortest,and the operation time of group C was the longest,and the operation time of group A was between group B and group C,with significant difference among the 3 groups( P < 0. 05). Intraoperative blood loss,exhaust time,defecation time,feeding time and length of hospital stay of group A were significantly shorter than group B and group C( P< 0. 05),while group B and group C is no statistical difference( P > 0. 05). The incidence of incision infection and abdominal infection in group A was significantly lower than that of group B and group C( P < 0. 05),while group B and group C had no statistical difference( P > 0. 05). There was no statistical difference among the 3 groups of anastomotic fistula,anastomotic bleeding,intestinal obstruction,secondary operation and pulmonary infection( P > 0. 05). Conclusion The clinical effect of laparoscopic surgery in elderly patients with colorectal cancer is relatively good,the short-term prognosis of conversion of laparoscopic surgery to open surgery is similar to that of open surgery,which does not have a greater impact on elderly patients.
Objective To investigate the effect of short-term prognosis on conversion of laparoscopic colorectal cancer surgery to open surgery of old patients. Methods 109 elderly patients with colorectal cancer surgery were selected,and were divided into 3 groups according to the surgical method,61 patients underwent laparoscopic surgery in group A,30 patients underwent open surgery in group B,and 18 patients underwent conversion of laparoscopic surgery to open surgery in group C. The causes of conversion were analyzed and the related indexes of perioperative period and postoperative complications were compared. Results The causes of laparoscopic colorectal cancer surgery in elderly patients were mainly due to the adhesion of the tumor and surrounding tissues,edema of the intestinal canal,large tumor volume,location fixation and the difficulty of laparoscopic operation.The operation time of group B was the shortest,and the operation time of group C was the longest,and the operation time of group A was between group B and group C,with significant difference among the 3 groups( P < 0. 05). Intraoperative blood loss,exhaust time,defecation time,feeding time and length of hospital stay of group A were significantly shorter than group B and group C( P< 0. 05),while group B and group C is no statistical difference( P > 0. 05). The incidence of incision infection and abdominal infection in group A was significantly lower than that of group B and group C( P < 0. 05),while group B and group C had no statistical difference( P > 0. 05). There was no statistical difference among the 3 groups of anastomotic fistula,anastomotic bleeding,intestinal obstruction,secondary operation and pulmonary infection( P > 0. 05). Conclusion The clinical effect of laparoscopic surgery in elderly patients with colorectal cancer is relatively good,the short-term prognosis of conversion of laparoscopic surgery to open surgery is similar to that of open surgery,which does not have a greater impact on elderly patients.
引文
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[8]王清,陈继明,高红艳.妇科腹腔镜手术中转开腹的原因分析[J].腹腔镜外科杂志,2017,22(10):789-792.
[2]宋均飞,刘弋.EGFR、HER2在结直肠癌患者血清与组织中的表达及其临床意义分析[J].中华疾病控制杂志,2016,20(4):403-407.
[3]丁志海,王卫,熊瑞,等.腔镜与开腹手术治疗老年结直肠癌手术效果及术后并发症观察[J].山西医药杂志,2017,30(21):2598-2600.
[4]王永鹏,佟昕,张庆彤,等.腹腔镜直肠癌前切除术中转开腹影响因素的多因素分析[J].中国微创外科杂志,2016,16(8):694-697.
[5]赵文河,任光辉,李红霞.腹腔镜结肠癌根治术对老年结直肠癌患者胃肠功能与并发症的影响[J].医学综述,2016,22(22):4565-4567.
[6]卢铁成,周天民,房莉,等.腹腔镜胆囊切除术中转开腹相关因素分析[J].中国普外基础与临床杂志,2016,23(1):97-99.
[7]罗东,刘国栋,唐能,等.腹腔镜胆囊切除术中转开腹的临床分析:附39例报告[J].中国普通外科杂志,2017,26(2):157-165.
[8]王清,陈继明,高红艳.妇科腹腔镜手术中转开腹的原因分析[J].腹腔镜外科杂志,2017,22(10):789-792.